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Job Application - Sullivan & Orange Counties

Pre-Application for Employment - Sullivan & Orange Counties Positions
Section I
Referred by

Section II
Street Address or PO Box
Best Time To Reach You
Are your work records under another name/names? If yes please specify
Have you previously filed an application with SullivanArc, Arc of Orange County, The Arc Sullivan-Orange Counties or The Arc Dutchess?
Have you previously been employed by The Arc Greater Hudson Valley, SullivanArc, The Arc of Orange County, The Arc Sullivan-Orange, or The Arc of Dutchess?
Are you 18 or over?
Schedule Desired:
(check all that apply):
Are you legally eligible for employment in the U.S.A.?
Have you ever been convicted of a crime or have any pending charges? If yes provide date and specify below
Do you have a history of substantiated abuse on file in the OPWDD, OMH or DOH system? If yes provide date and specify below

Section III
Please be advised that employment offers will be conditional for those positions that require driving. No firm offer will be made until verification of your license and driving history has been completed. Do you currently have a valid NYS or Out of State driver's license?